近视与远视患者FS-LASIK术后角膜上皮重塑及其对视力的影响  

Corneal Epithelial Remodeling and Its Impact on Visual Acuity in Myopic and Hyperopic Patients Following FS-LASIK

作　　者：赵雪琪 王慧娴 张旭 李文静 Xueqi Zhao;Huixian Wang;Xu Zhang;Wenjing Li(Shihezi University,Shihezi 832000,China;Ophthalmology Refractive Surgery Center of Xinjiang 474 Hospital,Urumqi 830000,China)

机构地区：[1]石河子大学,石河子832000 [2]新疆四七四医院眼科屈光手术中心,乌鲁木齐830000

出　　处：《中华眼视光学与视觉科学杂志》2024年第12期888-896,共9页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：乌鲁木齐市卫生健康委科技计划项目(202359、202361);新疆军区总医院北京路医疗区青年培育科研项目(2022jzbjl03)

摘　　要：目的:使用光谱域光学相干断层扫描(SD-OCT)观察近视与远视患者行飞秒激光辅助的准分子激光原位角膜磨镶术(FS-LASIK)后角膜上皮厚度变化情况及其对视力的影响。方法:前瞻性临床研究。连续性纳入2022年12月至2023年3月于新疆四七四医院屈光手术中心接受FS-LASIK手术的近视患者109例(109眼),远视患者20例(20眼),于术前、术后1周及1、3、6个月使用SD-OCT测量角膜扫描直径9 mm范围(4个环区细分为25个区域)的角膜上皮厚度。分别对近视与远视患者采用重复测量方差分析同一区域不同随访时间、同一时间不同区域的角膜上皮厚度,以及术后随访期间裸眼视力(UCVA)、最佳矫正视力(BCVA)。用Pearson相关分析近视与远视患者术后6个月时UCVA、BCVA与角膜上皮厚度变化量之间的关系。结果:与术前基线相比,近视患者术后6个月时中央区、旁中央区、中周区、周边区角膜上皮的厚度变化量分别为(6.11±0.67)(5.85±0.62)(1.21±0.35)(-1.74±0.65)μm。4个环区术后1周与术前、术后1个月相比,角膜上皮厚度差异有统计学意义(F=44.03、59.59、75.03、66.63,均P<0.001)。远视患者中周区及周边区于术后3个月与1个月相比,角膜上皮厚度差异有统计学意义(F=27.02,P<0.001;F=75.60,P<0.001);术后6个月时中央区、旁中央区、中周区、周边区角膜上皮厚度较术前变化分别为(-6.70±0.54)(-5.30±0.78)(4.60±1.35)(10.80±1.48)μm。近视及远视患者术后UCVA与术前BCVA相比差异有统计学意义(F=67.86,P<0.001;F=40.20,P<0.001)。术后6个月时,近视患者周边区、中周区鼻下角膜上皮厚度的变化量与UCVA的改善呈负相关(r=-0.23,P=0.023;r=-0.23,P=0.022);远视患者旁中央区正上方、旁中央区与周边区正下方角膜上皮厚度的变化量与UCVA的改善呈相关关系(r=0.48,P=0.026;r=-0.52,P=0.019;r=-0.47,P=0.035)。结论:FS-LASIK术后,近视与远视患者角膜上皮均在主要切削区域增厚,且术�Objective:To observe changes in corneal epithelial thickness and their impact on visual acuity using spectral-domain optical coherence tomography(SD-OCT)in myopic and hyperopic patients undergoing femtosecond laser-assisted in situ keratomileusis(FS-LASIK).Methods:This was a prospective clinical study.A total of 109 myopic patients(109 eyes)and 20 hyperopic patients(20 eyes)who underwent FS-LASIK at the Refractive Surgery Center of Xinjiang 474 Hospital from December 2022 to March 2023 were consecutively enrolled.SD-OCT was used to measure the corneal epithelial thickness within a 9 mm scanning diameter(divided into 25 regions across 4 concentric zones)preoperatively,and at 1 week,1 month,3 months,and 6 months postoperatively.Repeated measures ANOVA was utilized to analyze variations in corneal epithelial thickness between different follow-up time points within the same region,and between various regions at the same time point,as well as changes in uncorrected visual acuity(UCVA)and best-corrected visual acuity(BCVA)during the postoperative follow-up period for both myopic and hyperopic patients.Pearson correlation analysis was used to examine the relationship between UCVA and BCVA at 6 months postoperatively and changes in corneal epithelial thickness in myopic and hyperopic patients.Results:Compared to the preoperative baseline,the average corneal epithelial thickness changes in the central,paracentral,mid-peripheral,and peripheral zones of myopic patients at 6 months postoperatively were 6.11±0.67,5.85±0.62,1.21±0.35 and-1.74±0.65μm,respectively.The differences in corneal epithelial thickness among the four zones at 1 week and 1 month postoperatively compared to preoperative measurements were statistically significant(F=44.03,59.59,75.03,66.63,all P<0.001).For hyperopic patients,the differences in epithelial thickness in the mid-peripheral and peripheral zones at 3 months compared to 1 month postoperatively were statistically significant(F=27.02,P<0.001;F=75.60,P<0.001).At 6 months postoperatively,the ave

关 键 词：屈光外科手术 角膜上皮厚度 光学相干断层扫描 近视 远视 

分 类 号：R779.63[医药卫生—眼科]